Skip to main content
×
×
Home

A carbohydrate-reduced high-protein diet acutely decreases postprandial and diurnal glucose excursions in type 2 diabetes patients

  • Amirsalar Samkani (a1), Mads J. Skytte (a1), Daniel Kandel (a1), Stine Kjaer (a1), Arne Astrup (a2), Carolyn F. Deacon (a3), Jens J. Holst (a3) (a4), Sten Madsbad (a5), Jens F. Rehfeld (a6), Steen B. Haugaard (a1) and Thure Krarup (a1)...
Abstract

The aim of the study was to assess whether a simple substitution of carbohydrate in the conventionally recommended diet with protein and fat would result in a clinically meaningful reduction in postprandial hyperglycaemia in subjects with type 2 diabetes mellitus (T2DM). In all, sixteen subjects with T2DM treated with metformin only, fourteen male, with a median age of 65 (43–70) years, HbA1c of 6·5 % (47 mmol/l) (5·5–8·3 % (37–67 mmol/l)) and a BMI of 30 (sd 4·4) kg/m2 participated in the randomised, cross-over study. A carbohydrate-reduced high-protein (CRHP) diet was compared with an iso-energetic conventional diabetes (CD) diet. Macronutrient contents of the CRHP/CD diets consisted of 31/54 % energy from carbohydrate, 29/16 % energy from protein and 40/30 % energy from fat, respectively. Each diet was consumed on 2 consecutive days in a randomised order. Postprandial glycaemia, pancreatic and gut hormones, as well as satiety, were evaluated at breakfast and lunch. Compared with the CD diet, the CRHP diet reduced postprandial AUC of glucose by 14 %, insulin by 22 % and glucose-dependent insulinotropic polypeptide by 17 % (all P<0·001), respectively. Correspondingly, glucagon AUC increased by 33 % (P<0·001), cholecystokinin by 24 % (P=0·004) and satiety scores by 7 % (P=0·035), respectively. A moderate reduction in carbohydrate with an increase in fat and protein in the diet, compared with an energy-matched CD diet, greatly reduced postprandial glucose excursions and resulted in increased satiety in patients with well-controlled T2DM.

Copyright
Corresponding author
* Corresponding author: A. Samkani, email amsam03@gmail.com
References
Hide All
1. Sudhir, R & Mohan, V (2002) Postprandial hyperglycemia in patients with type 2 diabetes mellitus. Treat Endocrinol 1, 105116.
2. Cavalot, F, Petrelli, A, Traversa, M, et al. (2006) Postprandial blood glucose is a stronger predictor of cardiovascular events than fasting blood glucose in type 2 diabetes mellitus, particularly in women: lessons from the San Luigi Gonzaga Diabetes Study. J Clin Endocrinol Metab 91, 813819.
3. Hanefeld, M, Fischer, S, Julius, U, et al. (1996) Risk factors for myocardial infarction and death in newly detected NIDDM: the Diabetes Intervention Study, 11-year follow-up. Diabetologia 39, 15771583.
4. Monnier, L, Lapinski, H & Colette, C (2003) Contributions of fasting and postprandial plasma glucose increments to the overall diurnal hyperglycemia of type 2 diabetic patients: variations with increasing levels of HbA(1c). Diabetes Care 26, 881885.
5. Monnier, L, Colette, C & Owens, D (2011) Postprandial and basal glucose in type 2 diabetes: assessment and respective impacts. Diabetes Technol Ther 13, Suppl. 1, S25S32.
6. American Diabetes Association (2016) 7. Approaches to glycemic treatment. Diabetes Care 39, Suppl. 1, S52S59.
7. Strohacker, K, McCaffery, JM, MacLean, PS, et al. (2014) Adaptations of leptin, ghrelin or insulin during weight loss as predictors of weight regain: a review of current literature. Int J Obes (Lond) 38, 388396.
8. Evert, AB, Boucher, JL, Cypress, M, et al. (2014) Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care 37, Suppl. 1, S120S143.
9. Gannon, MC & Nuttall, FQ (2004) Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes. Diabetes 53, 23752382.
10. Pearce, KL, Noakes, M, Keogh, J, et al. (2008) Effect of carbohydrate distribution on postprandial glucose peaks with the use of continuous glucose monitoring in type 2 diabetes. Am J Clin Nutr 87, 638644.
11. Nuttall, FQ, Almokayyad, RM & Gannon, MC (2015) Comparison of a carbohydrate-free diet vs. fasting on plasma glucose, insulin and glucagon in type 2 diabetes. Metabolism 64, 253262.
12. Madsbad, S (2014) The role of glucagon-like peptide-1 impairment in obesity and potential therapeutic implications. Diabetes Obes Metab 16, 921.
13. Wallace, TM, Levy, JC & Matthews, DR (2004) Use and abuse of HOMA modeling. Diabetes Care 27, 14871495.
14. American Diabetes Association (2015) (2) Classification and diagnosis of diabetes. Diabetes Care 38, Suppl., S8S16.
15. Mann, JI, De Leeuw, I, Hermansen, K, et al. (2004) Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus. Nutr Metab Cardiovasc Dis 14, 373394.
16. Nielsen, S, Hensrud, DD, Romanski, S, et al. (2000) Body composition and resting energy expenditure in humans: role of fat, fat-free mass and extracellular fluid. Int J Obes Relat Metab Disord 24, 11531157.
17. Gibbons, C, Finlayson, G, Dalton, M, et al. (2014) Metabolic Phenotyping Guidelines: studying eating behaviour in humans. J Endocrinol 222, G1G12.
18. Belza, A, Ritz, C, Sorensen, MQ, et al. (2013) Contribution of gastroenteropancreatic appetite hormones to protein-induced satiety. Am J Clin Nutr 97, 980989.
19. Chaput, JP, Gilbert, JA, Gregersen, NT, et al. (2010) Comparison of 150-mm versus 100-mm visual analogue scales in free living adult subjects. Appetite 54, 583586.
20. Rehfeld, JF (1998) Accurate measurement of cholecystokinin in plasma. Clin Chem 44, 9911001.
21. Torang, S, Bojsen-Moller, KN, Svane, MS, et al. (2016) In vivo and in vitro degradation of peptide YY3-36 to inactive peptide YY3-34 in humans. Am J Physiol Regul Integr Comp Physiol 310, R866R874.
22. Orskov, C, Rabenhoj, L, Wettergren, A, et al. (1994) Tissue and plasma concentrations of amidated and glycine-extended glucagon-like peptide I in humans. Diabetes 43, 535539.
23. Krarup, T, Madsbad, S, Moody, AJ, et al. (1983) Diminished immunoreactive gastric inhibitory polypeptide response to a meal in newly diagnosed type I (insulin-dependent) diabetics. J Clin Endocrinol Metab 56, 13061312.
24. Lund, A, Bagger, JI, Wewer Albrechtsen, NJ, et al. (2016) Evidence of extrapancreatic glucagon secretion in man. Diabetes 65, 585597.
25. Wewer Albrechtsen, NJ, Hartmann, B, Veedfald, S, et al. (2014) Hyperglucagonaemia analysed by glucagon sandwich ELISA: nonspecific interference or truly elevated levels? Diabetologia 57, 19191926.
26. Van Cauter, E, Mestrez, F, Sturis, J, et al. (1992) Estimation of insulin secretion rates from C-peptide levels. Comparison of individual and standard kinetic parameters for C-peptide clearance. Diabetes 41, 368377.
27. Hovorka, R, Soons, PA & Young, MA (1996) ISEC: a program to calculate insulin secretion. Comput Methods Programs Biomed 50, 253264.
28. Gonzalez, JT & Stevenson, EJ (2014) Calcium co-ingestion augments postprandial glucose-dependent insulinotropic peptide(1-42), glucagon-like peptide-1 and insulin concentrations in humans. Eur J Nutr 53, 375385.
29. Chandalia, M, Garg, A, Lutjohann, D, et al. (2000) Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus. N Engl J Med 342, 13921398.
30. Koopmans, SJ, Ohman, L, Haywood, JR, et al. (1997) Seven days of euglycemic hyperinsulinemia induces insulin resistance for glucose metabolism but not hypertension, elevated catecholamine levels, or increased sodium retention in conscious normal rats. Diabetes 46, 15721578.
31. Willett, W, Manson, J & Liu, S (2002) Glycemic index, glycemic load, and risk of type 2 diabetes. Am J Clin Nutr 76, 274S280S.
32. Yoon, YS, Keum, N, Zhang, X, et al. (2015) Hyperinsulinemia, insulin resistance and colorectal adenomas: a meta-analysis. Metabolism 64, 13241333.
33. Kaiser, N, Leibowitz, G & Nesher, R (2003) Glucotoxicity and beta-cell failure in type 2 diabetes mellitus. J Pediatr Endocrinol Metab 16, 522.
34. Del Prato, S, Leonetti, F, Simonson, DC, et al. (1994) Effect of sustained physiologic hyperinsulinaemia and hyperglycaemia on insulin secretion and insulin sensitivity in man. Diabetologia 37, 10251035.
35. Guillausseau, PJ, Meas, T, Virally, M, et al. (2008) Abnormalities in insulin secretion in type 2 diabetes mellitus. Diabetes Metab 34, Suppl. 2, S43S48.
36. Steven, S, Hollingsworth, KG, Al-Mrabeh, A, et al. (2016) Very low-calorie diet and 6 months of weight stability in type 2 diabetes: pathophysiological changes in responders and nonresponders. Diabetes Care 39, 808815.
37. Frid, AH, Nilsson, M, Holst, JJ, et al. (2005) Effect of whey on blood glucose and insulin responses to composite breakfast and lunch meals in type 2 diabetic subjects. Am J Clin Nutr 82, 6975.
38. Lopez, S, Bermudez, B, Pacheco, YM, et al. (2008) Distinctive postprandial modulation of beta cell function and insulin sensitivity by dietary fats: monounsaturated compared with saturated fatty acids. Am J Clin Nutr 88, 638644.
39. Holst, JJ, Knop, FK, Vilsboll, T, et al. (2011) Loss of incretin effect is a specific, important, and early characteristic of type 2 diabetes. Diabetes Care 34, Suppl. 2, S251S257.
40. Lejeune, MP, Westerterp, KR, Adam, TC, et al. (2006) Ghrelin and glucagon-like peptide 1 concentrations, 24-h satiety, and energy and substrate metabolism during a high-protein diet and measured in a respiration chamber. Am J Clin Nutr 83, 8994.
41. Park, YM, Heden, TD, Liu, Y, et al. (2015) A high-protein breakfast induces greater insulin and glucose-dependent insulinotropic peptide responses to a subsequent lunch meal in individuals with type 2 diabetes. J Nutr 145, 452458.
42. Gibbons, C, Finlayson, G, Caudwell, P, et al. (2016) Postprandial profiles of CCK after high fat and high carbohydrate meals and the relationship to satiety in humans. Peptides 77, 38.
43. Nolan, LJ, Guss, JL, Liddle, RA, et al. (2003) Elevated plasma cholecystokinin and appetitive ratings after consumption of a liquid meal in humans. Nutrition 19, 553557.
44. Maruyama, H, Hisatomi, A, Orci, L, et al. (1984) Insulin within islets is a physiologic glucagon release inhibitor. J Clin Invest 74, 22962299.
45. Delzenne, N, Blundell, J, Brouns, F, et al. (2010) Gastrointestinal targets of appetite regulation in humans. Obes Rev 11, 234250.
46. Essah, PA, Levy, JR, Sistrun, SN, et al. (2007) Effect of macronutrient composition on postprandial peptide YY levels. J Clin Endocrinol Metab 92, 40524055.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

British Journal of Nutrition
  • ISSN: 0007-1145
  • EISSN: 1475-2662
  • URL: /core/journals/british-journal-of-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

" class="button small radius grey keywords">
β-cell glucose sensitivity
  • cholecystokinin
  • " class="button small radius grey keywords">
    cholecystokinin
  • conventional diabetes
  • " class="button small radius grey keywords">
    conventional diabetes
  • carbohydrate-reduced high protein
  • " class="button small radius grey keywords">
    carbohydrate-reduced high protein
  • composite satiety score
  • " class="button small radius grey keywords">
    composite satiety score
  • glucose-dependent insulinotropic polypeptide
  • " class="button small radius grey keywords">
    glucose-dependent insulinotropic polypeptide
  • glucagon-like peptide-1
  • " class="button small radius grey keywords">
    glucagon-like peptide-1
  • insulin secretion rate
  • " class="button small radius grey keywords">
    insulin secretion rate
  • peptide YY" class="button small radius grey keywords">
    peptide YY
  • type 2 diabetes mellitus" class="button small radius grey keywords">
    type 2 diabetes mellitus
  • total energy expenditure" class="button small radius grey keywords">
    total energy expenditure
  • visual analogue scale" class="button small radius grey keywords">
    visual analogue scale
  • Metrics

    Altmetric attention score

    Full text views

    Total number of HTML views: 29
    Total number of PDF views: 188 *
    Loading metrics...

    Abstract views

    Total abstract views: 12487 *
    Loading metrics...

    * Views captured on Cambridge Core between 12th April 2018 - 16th August 2018. This data will be updated every 24 hours.